Host employer declaration: Read the following and sign the document. I declare:

•I have read the Workplace Learning Guide for Employers and am aware of my rights and obligations to provide a safe and positive work environment for the student.

•If applicable, the vehicle in which the student is travelling is registered, the driver is licensed for the vehicle they will be driving, and provisional license holders comply with all their conditions.

•I will provide planned learning and skill development activities appropriate for the student under my supervision or that of a capable and trustworthy employee (not apprentice/trainee) briefed for the task.

•I confirm that the activities assigned are suitable for the student and that WHS risks have been assessed and managed in accordance with the Work Health and Safety Act 2011 (NSW).

•I will check any health care concerns with the student and ensure they and their supervisor know what to doing the case of an emergency i.e. where the student will keep their medication or adrenaline auto- injector-EpiPen.

•I will consult and cooperate with the school and will notify the school immediately of any health andsafety incidents involving a student while on placement, including near misses.

•I will ensure that before the student commences their placement, they are provided a site-specific workplace induction and then with the appropriate information, instruction, training, supervision (and personal protective equipment where needed) throughout the placement.

•I acknowledge that the student will not be paid during the placement.

•I will notify the school immediately if the student is ill, injured, absent without explanation or behaving inappropriately or I need to change sites or find asbestos on the site.

•I am not aware of anything in the background of any staff member or other person who will have close contact with the student that would preclude that staff member or person from working with children.

•I have informed employees of their obligations when working with children and young people.

•I am aware of the specific restrictions and prohibited activities for students and will ensure students are not asked to carry out any of these activities.

•I will provide the student with access to toilet facilities. drinking water and if required, first aid during the placement.

•I confirm my workplace is following the NSW government guidelines on COVID.

•I agree to all the above statements and will retain this document only for the period of the placement.

Privacy notice: The information requested on this form is being collected by the Department of Education (the department). The department will use the information for the following purposes:

(i)Coordinating a workplace learning opportunity for the school student.

(ii)Meet student health, duty of care and child protection responsibilities.

(iii)Support the information needs of the student, host employer and the parent/carer.

Provision of this information is voluntary, however, if you do not provide all or any of the information requested the student may not be able to undertake the planned workplace learning. The department might share the information with a Work Placement Service Provider for the purpose of organising HSC VET work placements but only with the approval of the principal. You have the right to access and correct the information you provide. If you wish to do so, please contact the student’s school. Information you provide will be stored securely and kept for a minimum of three years where there is no further action relating to the placement.

Student Placement Record

Wadalba Community School